Incomplete Exam (Category 0)

Prior chest CT being located for comparison Part or all of lungs cannot be evaluated Findings suggestive of infectious/inflammatory process (1-3 month LDCT)

Airway Location *

Subsegmental airway abnormalities often favor infectious process. Segmental or more proximal lesions are more concerning (4A at baseline, 4B if stable/growing).

Cyst Wall Thickness *

Thin-walled unilocular cysts (< 2 mm uniform wall) are benign. Thick-walled or multilocular cysts require follow-up.

Additional Cyst Characteristics

Multilocular (internal septations) Growing wall thickness or nodularity Increased loculation or new/increased opacity

Benign Features

Benign calcification (complete, central, popcorn, or concentric ring) Fat-containing Juxtapleural nodule

Shape (if < 10 mm, solid, smooth margins):

Suspicious Features (4X Modifiers)

Spiculation Suspicious lymphadenopathy Evidence of frank metastatic disease GGN doubling in size within 1 year

Category 4X applies to Cat 3 or 4 nodules with additional suspicious features. 4X is a distinct category, not a modifier.

S-Modifier: Significant or potentially significant findings unrelated to lung cancer

Examples: coronary calcification, emphysema, interstitial lung disease, adrenal nodule. Refer to ACR Incidental Findings guidelines.

Quick Reference: Size Thresholds with Volumes

Solid Nodule (Baseline)

Cat 2: < 6 mm < 113 mm³
Cat 3: 6-8 mm 113-268 mm³
Cat 4A: 8-15 mm 268-1,767 mm³
Cat 4B: ≥ 15 mm ≥ 1,767 mm³

Solid Nodule (New)

Cat 2: < 4 mm < 34 mm³
Cat 3: 4-6 mm 34-113 mm³
Cat 4A: 6-8 mm 113-268 mm³
Cat 4B: ≥ 8 mm ≥ 268 mm³

Part-Solid (Baseline)

Cat 2: Total < 6 mm < 113 mm³
Cat 3: Total ≥ 6 mm, solid < 6 mm
Cat 4A: Solid 6-8 mm 113-268 mm³
Cat 4B: Solid ≥ 8 mm ≥ 268 mm³

Non-Solid / GGN

Cat 2: < 30 mm < 14,137 mm³
Cat 3: ≥ 30 mm (baseline/new) ≥ 14,137 mm³
Cat 2: ≥ 30 mm stable/slow growing

Growth Definition: > 1.5 mm increase in mean diameter (> 2 mm³ volume) within a 12-month interval.
Juxtapleural: < 10 mm (≤ 24 mm³), solid, smooth margins, oval/lentiform/triangular = Category 2.

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Lung-RADS Calculator

Benign Features

Suspicious Features (4X Modifiers)

Quick Reference: Size Thresholds with Volumes

Solid Nodule (Baseline)

Solid Nodule (New)

Part-Solid (Baseline)

Non-Solid / GGN

Lung-RADS Results

IMPRESSION:

Calculation History

Lung-RADS Calculator

Benign Features

Suspicious Features (4X Modifiers)

Quick Reference: Size Thresholds with Volumes

Solid Nodule (Baseline)

Solid Nodule (New)

Part-Solid (Baseline)

Non-Solid / GGN

Lung-RADS Results

IMPRESSION:

Calculation History

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